If you’re a dedicated claims professional looking to take the next step in your career, we encourage you to apply today and join a team that values accuracy, integrity, and excellence.

Job Title: Senior Claims Examiner
Location: Bakersfield, CA - ONSITE
Full-Time | Direct Hire
Pay: $23.00 – $31.00 per hour (DOE)
Schedule: Monday – Friday

About the Role:
We are seeking a highly skilled and detail-oriented Senior Claims Examiner to join our team. This is a direct hire opportunity for a seasoned professional with a strong background in healthcare claims auditing and processing. The ideal candidate will have at least 5 years of experience in a similar role, a stable work history, and a deep understanding of managed care, coding standards, and claims systems. This position is perfect for someone who thrives in a fast-paced environment and is ready to make an immediate impact.

Key Responsibilities:
Review, audit, and process professional and institutional healthcare claims with a high degree of accuracy.
Identify and resolve discrepancies, overpayments, underpayments, and system configuration issues.
Conduct retrospective audits and apply McKesson Claim Check software to ensure claims accuracy.
Interpret and apply CPT, ICD-9/10, HCPCS, DRG, and RBRVS coding standards.
Analyze health plan and provider contracts, including Division of Financial Responsibility (DOFR).
Collaborate with internal departments to resolve configuration and adjudication issues.
Maintain compliance with CMS guidelines and managed care regulations.
Assist in training new staff and provide feedback to claims processors and examiners.
Support health plan audits and special projects as needed.
Qualifications:
Minimum 5 years of experience in healthcare claims examining and auditing.
Strong knowledge of managed healthcare, DOFRs, and various fee schedules.
Proficient in Microsoft Office and claims systems such as EZ-CAP, QNXT, MediTrac, IDX, and McKesson Claim Check.
Excellent understanding of CPT, ICD-9/10, HCPCS, DRG, and RBRVS coding.
Strong analytical, organizational, and problem-solving skills.
High attention to detail and accuracy in a production-based environment.
Stable work history with no significant employment gaps or job-hopping.


Apply for this great position as a senior claims examiner - healthcare today!
Contact Yarely Villalpando at Bakersfield AppleOne yvillalpando(@)appleone.com

Equal Opportunity Employer / Disabled / Protected Veterans

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For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

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We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.